MEDICARE: THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BCBS PROVIDER	OTHER	IL	1622185

General Provider Information

NPI Number	:	1760400170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Provider Business Mailing Address
First Line	:	1220 S. WOOD STREET
Second Line	:	UIH-MILE SQUARE HEALTH CENTER
City	:	CHICAGO
State	:	IL
Zip	:	60608-1202
Country	:	US
Telephone Number	:	312-413-1261
Fax Number	:	312-413-7815

Provider Business Practice Location Address
First Line	:	7037 S. STONY ISLAND
Second Line	:	UIH-MILE SQUARE HEALTH CENTER AT SOUTH SHORE
City	:	CHICAGO
State	:	IL
Zip	:	60649
Country	:	US
Telephone Number	:	773-256-0526
Fax Number	:	312-413-7812

Authorized Official
Title or Position	:	CFO
Name	:	MR. TIMOTHY STECKER
Credential	:
Telephone Number	:	312-355-7653

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/10/2025

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Directions to “THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS ” Practice Location

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